insurance scams in the time of the virus

Wendell Potter@wendellpotter
WORD TO THE WISE>> During this coronavirus crisis, keep an eye on every move of my old industry: health insurers. Behind the PR spin, they will be doing everything they can to deny care & maintain profits, while making it look like they’re heroes. Here’s what to look for: (1/10)

The president said that insurers “have agreed to waive all copayments for coronavirus treatments.” Don’t count on that. Insurers’ biggest trade group (“AHIP”) said soon after Trump’s speech that what insurers would waive would be cost-sharing for testing. Not treatment. (2/10)

You can be sure Trump’s comment sent shockwaves through the industry. For many, treatment will be way more expensive than testing. If insurers let their enrollees (YOU) off the hook for out-of-pocket expenses related to treatment, their shareholders would be apoplectic. (3/10)

Case in point: My old company Cigna says it will cover the cost of COVID-19 testing — but makes no mention of waiving copays or deductibles for *treatment*. Check out their carefully crafted wording here: (4/10)
https://cigna.com/individuals-families/health-wellness/topic-disaster-resource-center/coronavirus-public-resources

Here’s another: UnitedHealthcare says “your health is important to [them]” and their top “priority.” But if you actually get this coronavirus, good luck with out of pocket costs (5/10)

One of the most-watched metrics for health insurance companies is called the “medical loss ratio.” The more insurers pay for care, the higher the ratio is. (It’s called the medical loss ratio because insurers consider it a loss when they pay a claim.) 6/10

As part of Obamacare, insurers have to spend at least 80-85% of premiums on health care. So most try to keep the ratio right at those levels. If it creeps up significantly, shareholders run for the exits. Why? When insurers pay more in claims, that’s less $ for profits. (7/10)

Remember: For-profit insurers are in the business to make a profit. Period. And they do better when you don’t need them or remember they exist. But when a crisis like this erupts, they get scared. Why? Because folks like you will see what they really do and don’t cover. (8/10)

As a former insurance exec, let me tell you: The strategy of moving Americans into high deductible plans has paid off beautifully for shareholders & top execs. But it’s forcing millions of Americans to forego care, turn to GoFundMe or bankruptcy court due to awful bills. (9/10)

This pandemic will finally reveal how devastating insurers’ greed will be to so many of us. Tragically, some Americans will likely die because policymakers turned the keys of our healthcare system over to profit-driven insurance corporations.

That has to finally end.

(10/10)